Pregnancy Outcomes and Anxiety in Nulliparous Women [30E]

Abstract

INTRODUCTION: Maternal anxiety affects 20–35% of pregnancies. Both untreated anxiety and its medical therapy are associated with adverse pregnancy outcomes; however, data are mixed and limited. We examined pregnancy outcomes in women with treated and untreated anxiety in a well-characterized cohort. METHODS: An IRB approved secondary analysis of the NuMoM2b study, a prospective multi-center cohort of nulliparous women that included study visits each trimester and postpartum. Anxiety was assessed at 6w0d-13w6d using the State Trait Anxiety Inventory (STAI-T). Women were divided into three groups: anxiety and medical treatment, anxiety and no medical treatment, and no anxiety (controls). The primary outcome was a composite of preterm birth, abruption, hypertensive disorders of pregnancy, and small for gestational age. Potential confounders were adjusted for using multivariable logistic regression. RESULTS: Among 8,292 eligible women, 23.9% (n=1983) had anxiety; 311 were treated medically. The composite outcome occurred more often in women with untreated anxiety than controls (28.6% vs 25.9%, P=.02), with no difference between treated anxiety and controls (27.7% vs 25.9%, P=.5). The primary outcome increased across STAI-T score deciles (P<.009). After adjustments for confounders there were no differences in the primary outcome among groups, although untreated anxiety was associated with more neonatal intensive care unit stays >48 hours. CONCLUSION: Anxiety occurred in almost a quarter of nulliparas. Although untreated anxiety is associated with increased perinatal morbidity, other factors likely contribute. Treated anxiety was not associated with a change in perinatal outcomes. Given the frequency, the relationship between anxiety, associated factors, treatment and perinatal outcomes warrants further research.